Position Summary

A Quality Assurance Analyst I performs coding audits for quality checks and provider education.

Major Duties and Responsibilities

• Maintains working knowledge of coding and compliance.
• Provides coding training and support to all TPMG locations.
• Participates in coding-related denial meetings.
• Performs coding and auditing of medical record documentation to ensure accurate coding.
• Reviews and submits documentation for all Recovery Audit Contractors (RAC) requests; timely follow-up of RAC audit.
• Reviews and submits documentation for all Error Rate Testing (CERT) requests with timely follow up of CERT response.
• Reviews and submits documentation for Targeted Probe and Educate (TPE) requests.
• Reviews and submits documentation for medical record requests for all insurance carriers.
• Follows HIPPA guidelines.
• Works with providers and clinical staff to improve documentation.
• Works with the Central Billing Office team to ensure appropriate reimbursement.
• Reviews denied claims and retractions and makes appropriate corrections or advise if denial/retraction is warranted.
• Provides assistance with submitting appeals for denials/retractions.
• Works closely with Coding and Compliance Auditors and SWAT Team.
• Other duties as assigned.

Knowledge, Skills and Abilities

• 
  Knowledge of CPT, ICD-9, ICD-10 and HCPCS coding.
• Knowledge of appropriate medical terminology.
• Experience with NextGen and Encoder Pro is a plus.
• Ability to read and understand oral and written instructions and follow written protocols.
• Ability to examine documents for accuracy and completeness.
• Ability to provide excellent customer service.
• Ability to multi-task.
• Skill in presenting information in an organized manner.
• Skill in verbal and written communication.

Education / Training / Requirements

• 
  High School diploma/GED.
• Up to 2 years related experience/training.
• Up to 2 years in the medical billing field, with coding experience.
• Possess and maintain active CPC, CCS, COC, CCS-P, or CCA certification required.

Physical Demands

• 
  Ability to lift or move equipment.
• Ability to stand and walk for limited periods of time.
• Ability to sit for extended periods of time.
• Ability to enter data into a computer via a keyboard.
• Ability to occasionally reach, bend, stoop and lift up to 30 lbs. *
• Ability to grasp and hold up to 30 lbs.*
• Ability to occasionally squat and lean over.
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Ability to see and understand data on a computer screen.

Success Factors

• 
  Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail
• Accomplished in word processing and worksheet utilization

All statements are essential functions of the position unless identified as non-essential by an asterisk (*).